After Criticism, DSM Committee Changes Course

Experts behind the new version of the Diagnostic and Statistical Manual of Mental Disorders didn’t back down on major changes to the definition of autism, but appear to have made an about-face when it comes to intellectual disability.

Initial plans to revise the diagnosis of “mental retardation” in the forthcoming fifth edition of the psychiatric manual called for the condition to be renamed “intellectual developmental disorder.” Critics blasted the proposal because it was inconsistent with the more commonly accepted term “intellectual disability” which has already been adopted in many federal and state laws.

Now it appears that the American Psychiatric Association heard the complaints. In newly-released documents, officials from the psychiatrists’ group stopped short of revealing the final text for the manual, but now say the version slated for publication in May will replace “mental retardation” with “intellectual disability.” The move is an effort to align with the American Association on Intellectual and Developmental Disabilities, the U.S. Department of Education and other groups, the psychiatric association said.

The new term with be appended with a notation about “intellectual developmental disorder” in order to be congruent with language expected in an upcoming revision of the International Classification of Diseases, or ICD, a guide to diseases and disorders published by the World Health Organization.

“I’m really pleased that at least in the United States we won’t have a conflict in terminology,” said Margaret Nygren, executive director and CEO of AAIDD, who objected to the psychiatric association’s initial plan.

The new DSM will also bring changes to the criteria for the diagnosis of intellectual disability, with less emphasis on a person’s specific IQ score and more consideration for clinical assessment.

“The updated criteria will help clinicians develop a fuller, more accurate picture of patients, a critical step in providing them with effective treatment and services,” according to a fact sheet released by the psychiatric organization.

The alterations to the “mental retardation” diagnosis came largely in the shadow of changes to the way that autism is defined within the DSM. Despite significant criticism, those behind the new version of the manual did not waver on plans to eliminate Asperger’s syndrome and fold it as well as childhood disintegrative disorder and pervasive developmental disorder, not otherwise specified under the umbrella term “autism spectrum disorder.”

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My hope is that these definitions and redefinitions will not compromise the opportunities of anyone accessing the support and resources they need to become the best they can be. That will be a critical nightmare.